The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Factors influencing hepatocellular carcinoma prognosis after hepatectomy: a single-center experience

  • Park, Sung Keun (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Jung, Young Kul (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Chung, Dong Hae (Department of Pathology, Gachon University Gil Medical Center) ;
  • Kim, Keon Kuk (Department of Surgery, Gachon University Gil Medical Center) ;
  • Park, Yeon Ho (Department of Surgery, Gachon University Gil Medical Center) ;
  • Lee, Jung Nam (Department of Surgery, Gachon University Gil Medical Center) ;
  • Kwon, Oh Sang (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kim, Yun Soo (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Choi, Duck Joo (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kim, Ju Hyun (Department of Internal Medicine, Gachon University Gil Medical Center)
  • Published : 2013.07.01
⟨ Previous Next ⟩

Abstract

Background/Aims: Recurrence after hepatic resection is one of the most important factors impacting the prognosis and survival of patients with hepatocellular carcinoma (HCC). We identified prognostic factors affecting overall survival (OS) and disease-free survival (DFS) in patients with HCC after hepatic resection. Methods: This study was of a retrospective cohort design, and 126 patients who underwent hepatic resection for HCC at Gachon University Gil Medical Center between January 2005 and December 2010 were enrolled. Various clinical, laboratory, and pathological data were evaluated to determine the prognostic factors affecting OS and DFS. Results: Two- and 4-year OS and 2- and 4-year DFS were 78.1% and 65% and 51.1% and 26.6%, respectively. In a multivariate analysis, preoperative ${\alpha}$-fetoprotein (>400 ng/mL), tumor size (${\geq}$ 5 cm), multiple tumors (two or more nodules), presence of portal vein invasion, modified Union for International Cancer Control (UICC) stage III/IV, and Barcelona Clinic Liver Cancer (BCLC) stage B/C were independent prognostic factors affecting a shorter OS. In the multivariate analysis, presence of microvascular invasion, modified UICC stage III/IV, and BCLC stage B/C were independent prognostic factors for a shorter DFS. Conclusions: The presence of vascular invasion was an independent poor prognostic factor for OS and DFS in patients with HCC after hepatic resection. Thus, close postoperative surveillance for early detection of recurrence and additional treatments are urgently needed in patients with vascular invasion after hepatic resection.

Keywords

References

  1. Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol 2001;2:533-543. https://doi.org/10.1016/S1470-2045(01)00486-7
  2. Ministry of Heath and Welfare. 2008 Annual Report of Cancer Statistics in Korea. Gwacheon: Ministry of Heath and Welfare, 2010.
  3. Ministry of Heath and Welfare. Cancer Incidence in Korea 1999-2001. Gwacheon: Ministry of Heath and Welfare, 2005.
  4. Park JW, Kim CM. Epidemiology of hepatocellular carcinoma in Korea. Korean J Hepatol 2005;11:303-310.
  5. Sharma P, Balan V, Hernandez JL, et al. Liver transplantation for hepatocellular carcinoma: the MELD impact. Liver Transpl 2004;10:36-41. https://doi.org/10.1002/lt.20012
  6. Lee KU, Koh YT, Kim KH, et al. Prognostic factors of hepatocellular carcinoma after curative hepatic resection. Korean J Hepatobiliary Pancreat Surg 1997;1:41-58.
  7. Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 2001;234:63-70. https://doi.org/10.1097/00000658-200107000-00010
  8. Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 2003;238:703-710. https://doi.org/10.1097/01.sla.0000094549.11754.e6
  9. Ueno S, Tanabe G, Nuruki K, et al. Prognostic performance of the new classif ication of primary liver cancer of Japan (4th edition) for patients with hepatocellular carcinoma: a validation analysis. Hepatol Res 2002;24:395-403. https://doi.org/10.1016/S1386-6346(02)00144-4
  10. Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005;42:1208-1236. https://doi.org/10.1002/hep.20933
  11. Gouw AS, Balabaud C, Kusano H, Todo S, Ichida T, Kojiro M. Markers for microvascular invasion in hepatocellular carcinoma: where do we stand? Liver Transpl 2011;17 Suppl 2:S72-S80. https://doi.org/10.1002/lt.22368
  12. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130:417-422.
  13. Shah SA, Cleary SP, Wei AC, et al. Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes. Surgery 2007;141:330-339. https://doi.org/10.1016/j.surg.2006.06.028
  14. Kim SH, Choi SB, Lee JG, et al. Prognostic factors and 10-year survival in patients with hepatocellular carcinoma after curative hepatectomy. J Gastrointest Surg 2011;15:598-607. https://doi.org/10.1007/s11605-011-1452-7
  15. Song TJ, Ip EW, Fong Y. Hepatocellular carcinoma: current surgical management. Gastroenterology 2004;127(5 Suppl 1):S248-S260. https://doi.org/10.1053/j.gastro.2004.09.039
  16. Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999;229:790-799. https://doi.org/10.1097/00000658-199906000-00005
  17. Chen YL, Ko CJ, Chien SY, et al. Tumor size as a prognostic factor in resected small hepatocellular carcinoma: a controversy revisited. J Gastroenterol Hepatol 2011;26:851-857. https://doi.org/10.1111/j.1440-1746.2010.06595.x
  18. Calvet X, Bruix J, Gines P, et al. Prognostic factors of hepatocellular carcinoma in the west: a multivariate analysis in 206 patients. Hepatology 1990;12(4 Pt 1):753-760. https://doi.org/10.1002/hep.1840120422
  19. Song IH, Kim KS. Current status of liver diseases in Korea: hepatocellular carcinoma. Korean J Hepatol 2009;15 Suppl 6:S50-S59. https://doi.org/10.3350/kjhep.2009.15.S6.S50
  20. Oh KC, Park SH, Park JC, et al. Is the prevalence of cryptogenic hepatocellular carcinoma increasing in Korea? Korean J Gastroenterol 2005;45:45-51.
  21. Makuuchi M, Sano K. The surgical approach to HCC: our progress and results in Japan. Liver Transpl 2004;10:S46-S52. https://doi.org/10.1002/lt.20044
  22. Korean Liver Cancer Study Group; National Cancer Center, Korea. Practice guidelines for management of hepatocellular carcinoma 2009. Korean J Hepatol 2009;15:391-423. https://doi.org/10.3350/kjhep.2009.15.3.391
  23. Vitale A, Saracino E, Boccagni P, et al. Validation of the BCLC prognostic system in surgical hepatocellular cancer patients. Transplant Proc 2009;41:1260-1263. https://doi.org/10.1016/j.transproceed.2009.03.054
  24. Okuda K, Nakashima T, Obata H, Kubo Y. Clinicopathological studies of minute hepatocellular carcinoma: analysis of 20 cases, including 4 with hepatic resection. Gastroenterology 1977;73:109-115.
  25. Minagawa M, Ikai I, Matsuyama Y, Yamaoka Y, Makuuchi M. Staging of hepatocellular carcinoma: assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan. Ann Surg 2007;245:909-922. https://doi.org/10.1097/01.sla.0000254368.65878.da
  26. Vauthey JN, Lauwers GY, Esnaola NF, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol 2002;20:1527-1536. https://doi.org/10.1200/JCO.20.6.1527
  27. Jonas S, Bechstein WO, Steinmuller T, et al. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology 2001;33:1080-1086. https://doi.org/10.1053/jhep.2001.23561
  28. Lim KC, Chow PK, Allen JC, et al. Microvascular invasion is a better predictor of tumor recurrence and overall survival following surgical resection for hepatocellular carcinoma compared to the Milan criteria. Ann Surg 2011;254:108-113. https://doi.org/10.1097/SLA.0b013e31821ad884

Cited by

  1. Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinomas: A Meta-Analysis of Randomized and Nonrandomized Controlled Trials vol.9, pp.1, 2013, https://doi.org/10.1371/journal.pone.0084484
  2. Magnetic Resonance Imaging in Cirrhosis: What’s New? vol.23, pp.2, 2013, https://doi.org/10.1097/rmr.0000000000000017
  3. Can gamma-glutamyl transferase levels contribute to a better prognosis for patients with hepatocellular carcinoma? vol.8, pp.3, 2013, https://doi.org/10.5582/ddt.2014.01025
  4. The effectiveness of selective internal radiation therapy in challenging cases of liver-predominant unresectable hepatocellular carcinoma vol.10, pp.15, 2014, https://doi.org/10.2217/fon.14.218
  5. Management of hepatocellular carcinoma: Predictive value of immunohistochemical markers for postoperative survival vol.7, pp.1, 2013, https://doi.org/10.4254/wjh.v7.i1.7
  6. High Levels of Gamma-Glutamyl Transferase and Indocyanine Green Retention Rate at 15 min as Preoperative Predictors of Tumor Recurrence in Patients With Hepatocellular Carcinoma vol.94, pp.21, 2015, https://doi.org/10.1097/md.0000000000000810
  7. Establishment and Validation of SSCLIP Scoring System to Estimate Survival in Hepatocellular Carcinoma Patients Who Received Curative Liver Resection vol.10, pp.6, 2013, https://doi.org/10.1371/journal.pone.0129000
  8. A comparison of the risk factors of intrahepatic recurrence, early recurrencen, and multiple recurrences after resection for single nodular hepatocellular carcinoma vol.19, pp.3, 2013, https://doi.org/10.14701/kjhbps.2015.19.3.89
  9. Prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with Barcelona Clinic Liver Cancer stages 0 and A hepatocellular carcinomas: a multicenter retro vol.43, pp.9, 2013, https://doi.org/10.1007/s00259-016-3348-y
  10. A microRNA-based prediction model for lymph node metastasis in hepatocellular carcinoma vol.7, pp.3, 2013, https://doi.org/10.18632/oncotarget.6534
  11. Advances of diagnostic and mechanistic studies of γ-glutamyl transpeptidase in hepatocellular carcinoma vol.10, pp.4, 2013, https://doi.org/10.5582/ddt.2016.01052
  12. Predictive Value of Contrast-enhanced Ultrasound for Early Recurrence of Single Lesion Hepatocellular Carcinoma After Curative Resection vol.41, pp.1, 2013, https://doi.org/10.1177/0161734618815231
  13. Alpha-fetoprotein level to total tumor volume as a predictor of hepatocellular carcinoma recurrence after resection. A retrospective cohort study vol.54, pp.None, 2020, https://doi.org/10.1016/j.amsu.2020.04.014
  14. Tumor volume measured using MR volumetry as a predictor of prognosis after surgical resection of single hepatocellular carcinoma vol.144, pp.None, 2021, https://doi.org/10.1016/j.ejrad.2021.109962
  15. Impact of prognostic nutritional index on the recurrence of hepatocellular carcinoma after a curative resection vol.25, pp.4, 2013, https://doi.org/10.14701/ahbps.2021.25.4.456